Late onset spondylarthropathy: Clinical and biological comparison with early onset patients

Objective - To compare the clinical, radiological, and biological profile of patients presenting late onset spondylarthropathy (LOSPA) with patients with early onset spondylarthropathy (EOSPA). Methods - During the period April 1987 to April 1995 a retrospective chart review of inpatients and outpatients identified eight patients with LOSPA. They were matched with 32 patients with EOSPA examined during the same period of time. Clinical, radiological, and biological signs were compared. All patients fulfilled Amor criteria for spondylarthropathy. Results - Mean age of patients with LOSPA was 65.1 years (range 58-72), and 26.6 years (range 11-40) in patients with EOSPA. The sex ratio (female/male) was 5/3 in LOSPA and 9/23 in EOSPA (p = 0.007). Patients with LOSPA had more significantly cervical and dorsal pain (p = 0.002, p = 0.02 respectively), anterior chest wall involvement (p = 0.04), number of peripheral arthritis (p = 0.04), aseptic osteitis (p = 0.004), and systemic symptoms : fever, fatigue, weightless (p 0.04). Mean (SD) erythrocyte sedimentation rate was 87 (24) in LOSPA and 24 (35) in EOSPA patients (p = 0.001). Inflammatory bowel disease was diagnosed in three patients with EOSPA. A definite family history of SPA was found in 50% of patients with LOSPA and in 31% of patients with EOSPA. A clear response to NSAID was obtained in 62% of LOSPA patients and in 90.6% of EOSPA patients (p = 0.05). Three LOSPA patients (two with Crohn's disease) not responding to NSAID were successfully treated with prednisone. Conclusion - The onset of spondylarthropathy is uncommon after 55 years. Patients with LOSPA, according to accepted international criteria present a different clinical and biological profile when compared with younger patients. These results suggests that age may influence the presentation of SPA at onset.